74 posts tagged health

Gender-affirming surgeries tripled in the U.S. between 2016 and 2019

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Stat reports on new national estimates from a cohort study in JAMA Network Open.

Some findings:

The number of gender-affirming surgeries taking place in the U.S. nearly tripled between 2016 and 2019.

Over 56% of all surgeries in the four-year period were breast and chest procedures. People ages 19-30 were the recipients of over half of all surgeries, while youths ages 12-18 made up a small portion at 7.7%.

During the four-year span, only 3,678 people ages 12-18 received any type of gender-affirming surgery. The vast majority — over 3,200 — were breast or chest surgeries. In four years, only 405 youths across the country received genital surgery.

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“I do not know of a single patient who’s ever had any kind of genital surgery under the age of 18, of the hundreds, potentially thousands of kids that I’ve cared for,” said Katy Miller, the medical director of adolescent medicine at Children’s Minnesota. “So the idea that it’s easy to get gender-affirming surgery, I mean, any queer or trans person will tell you that’s simply not true.”

It is unclear what has caused the increase. Some point to increased awareness and support online, including more medical evidence regarding the safety and benefits of such surgeries. Some point to changes to insurance coverage of the care, others to an increase in trained professionals. Some even argue that many trans people are afraid such support will become unavailable in the future.

Read the whole article here.

New study: FTM transgender and nonbinary patients have no regrets about top surgery

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A new study, published Wednesday in the journal JAMA Surgery, shows that people who had a gender-affirming mastectomy (i.e. top surgery) had extremely low rates of decisional regret and extremely high levels of satisfaction with their decision to have the procedure, CNN reports.

The scientists sent a questionnaire to to patients who had undergone gender-affirming mastectomy at a US tertiary referral center between January 1, 1990, and February 29, 2020. A total of 235 patients were deemed eligible for the study, and 139 responded (59.1% response rate).

The median or average satisfaction score was 5 on a 5-point scale, with higher scores indicating higher satisfaction. The median decisional regret score was 0 on a 100-point scale, with lower scores indicating lower levels of regret.

Sure, the number of respondents is low, but the results speak volumes. As the researchers point out  the results are overwhelmingly positive compared with other medical and nonmedical decisions.

You can read the paper here:

Lauren Bruce, Alexander N. Khouri, Andrew Bolze et al: Long-Term Regret and Satisfaction With Decision Following Gender-Affirming Mastectomy

Illustration: Midjourney

//Virtually all of the research on gender-affirming care consists of observational studies. In fact, there are over 50 studies examining gender-affirming care from various perspectives.

The majority of these studies report large reductions in suicidality, depression, and anxiety. Though there is plenty of strong evidence for gender affirming care, it is observational in nature - and for good reason! Conducting RCTs for gender-affirming care is highly unethical and impossible. The physical effects of hormones are extremely evident, making blinding for such trials unfeasible.

Furthermore, it would be unethical to pretend to treat a transgender person with hormones while withholding them - no such study would ever get approved given the massive weight of evidence in the favor of gender affirming care.//

Puberty blockers have almost universally been shown to result in positive outcomes and to be safe

Over at CDL Lost247365 answers a question about the safety of puberty blockers in the treatment of transgender kids, and provides some really useful references to relevant science papers.

She writes:

Puberty blockers have almost universally been shown to result in positive outcomes and to be safe.

QUOTE: “Studies reviewed had samples ranging from 1 to 192 (N = 543). The majority (71%) of participants in these studies required a diagnosis of gender dysphoria to qualify for puberty suppression and were administered medication during Tanner stages 2 through 4. Positive outcomes were decreased suicidality in adulthood, improved affect and psychological functioning, and improved social life. Adverse factors associated with use were changes in body composition, slow growth, decreased height velocity, decreased bone turnover, cost of drugs, and lack of insurance coverage. One study met all quality criteria and was judged ‘excellent’, five studies met the majority of quality criteria resulting in 'good’ ratings, whereas three studies were judged fair and had serious risks of bias.”

https://www.aap.org/en/news-room/news-r … -blockers/

QUOTE: “Researchers found a 60% decrease in moderate and severe depression and 73% decrease in suicidality among transgender and non-binary youth who received puberty blockers or gender-affirming hormones over a 12-month period, according to a study abstract presented during the virtual American Academy of Pediatrics 2021 National Conference & Exhibition.”

https://publications.aap.org/pediatrics … redirected

QUOTE: “This is the first study in which associations between access to pubertal suppression and suicidality are examined. There is a significant inverse association between treatment with pubertal suppression during adolescence and lifetime suicidal ideation among transgender adults who ever wanted this treatment. These results align with past literature, suggesting that pubertal suppression for transgender adolescents who want this treatment is associated with favorable mental health outcomes.”

https://www.thelancet.com/journals/land … cestitle70

QUOTE: Gender incongruence in children and adolescents is complex, and medical treatment raises several ethical considerations. Clinical decision making has been fostered by research efforts, but there are still substantial knowledge gaps that warrant examination to inform best clinical practice (panel 4). The limited available evidence suggests that puberty suppression, when clearly indicated, is reasonably safe. The few studies that have examined the psychological effects of suppressing puberty, as the first stage before possible future commencement of CSH therapy, have shown benefits.

All of this should also show that puberty blockers are not experimental and are life saving:

QUOTE: “Puberty delaying medications are currently provided off label to adolescents affected by gender dysphoria and this particular use cannot be investigated by a RCT. We have shown that this does not mean they are experimental drugs or are provided experimentally. Whether or not these (or even approved drugs) are ethically prescribed depends on whether they are likely to serve the patient’s health interests based on the evidence available at the time of prescription.

"The published literature provides insight into the likely benefits of GnRHa. In summary, they reduce the patient’s dysphoria (Cohen-Kettenis & Pfäfflin, 2003, p. 171; Kreukels & Cohen-Kettenis, 2011, p. 467), reduce the invasiveness of future surgery (for example, mastectomy in trans men; treatment for facial and body hair, thyroid chondroplasty to improve appearance and cricothyroid approximation to raise the pitch of the voice in trans women) (Cohen-Kettenis & Pfäfflin, 2003, p. 171); GnRHa is correlated with improved psychosocial adaptation (Cohen-Kettenis & Pfäfflin, 2003, p. 171; Kreukels & Cohen-Kettenis, 2011, p. 467) and reduced suicidal ideation and attempts. Hembree noted increased suicidal ideation where blockers were not given (Hembree, 2011; see further, Imbimbo et al., 2009; Kreukels & Cohen-Kettenis, 2011; Murad et al., 2010; Spack, 2008).”

Some people think that puberty blockers might cause kids to think they are transgender and convince them to wrongfully go on to take HRT. The research shows this not to be true:

QUOTE: “In this cohort study of TGD adolescents, GnRHa use was not associated with increased subsequent GAH use. These findings suggest that clinicians can offer the benefits of GnRHa treatment without concern for increasing rates of future GAH use.”

Puberty blockers are in fact a wonder drug. Extremely safe and they can prevent trans kids from experiencing irreversible changes to their body due to the wrong puberty while they reach an age where they are old enough to consent. Similarly, they prevent confused Cis Children (who make up only about 2% of all the kids pursuing puberty blockers) from making a mistake that would create irreversible changes to their body as well. Meaning that this drug helps both trans and cis kids!

You can read the whole post here.


//Dr Meredithe McNamara, an expert in gender-affirming healthcare and adolescent medicine at the prestigious Yale School of Medicine, says such claims ignore the “reality” that trans healthcare has a long history in the US and beyond.

She believes that few, if any, of those seeking to restrict such care “have ever been to a gender clinic and talked with people”.

Speaking to PinkNews, she says: “I haven’t seen anything along those lines. If you came in and saw how long these conversations are with young people, with their parents, how much we talk about everything, every bit of disinformation would be dispelled.

“But the problem is nobody really seems interested in reality, and that’s the thing that I struggle with because I know that’s true. These politicians know that it’s true, but the truth doesn’t matter.”//

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Dr McNamara stresses that gender-affirming treatments are “far better tested than most things” physicians “provide in paediatrics”.

The American Medical Association, the American Academy of Pediatrics, the World Medical Association and many other medical organisations support gender-affirming care for trans adults and young people

More here.

Estrogen is Made from Testosterone and other T&E facts that will Confuse Bigots

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We been told this over and over again. Testosterone (T) is the male drug that makes men “real men”, and estrogen (E) is the female drug that makes women sweet and dainty. 

This is a story that makes the hypermasculine narrative about traditional gender roles seem “sciency”. The fact is, however, that this is not how the hormones work.

Did you know that E is made from T?

Gemma Stones writes over at twitter:

If you block your testosterone receptors then your T says “fuck this I’m transitioning” and becomes oestrogen. Your actual hormones themselves can change sex. This is a biology fact.

“Can people change sex” seems like a really fucking dim question in the face of facts like this huh.

This is also why gym bros who take T sometimes get lil titties. your T receptors can only handle so much and the rest of it has to go somewhere! so it becomes oestrogen!

More hormone facts I’ve been told today: Pretty much all of the E in everyone’s body was once an androgen like Testosterone. This happens more in bodies with ovaries because they have more of the enzyme that does it. All oestrogen is transgender.

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And here’s a fun graph showing that across a cis woman’s life time she has significantly more testosterone than oestrogen. again, smashing the binary thinking we have of these lil chemical boyos.

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[This graph is from a tweet by the urologist Ashley Winter MD, who writes: 

“So your whole life, you should have been shown a better graph. Like this one. With Y-axis labelling. Which shows that (in average over the lifespan), WOMEN HAVE MORE TESTOSTERONE THAT ESTRADIOL. Thats right. Every goddamn human has more testosterone than estradiol.”]

Photo from Barbie movie.

Them writes about the effects of testosterone hormone replacement therapy, and what anyone who consider going through such a process should know and keep in mind.

//Testosterone HRT is often used by transmasculine people and trans men to alleviate gender dysphoria, boost confidence, and feel more at home in their body and mind. Taking testosterone can lead to changes in primary and secondary sex characteristics, such as a deeper voice, increased facial and body hair, clitoral growth, fat redistribution, and increased muscle mass.//

Should transgender people use birth control?

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Helen Boyd Kramer got a question from a young  trans man  asking about  about birth control. Helen did some digging and got the following reply from a registered nurse:

Birth control is appropriate and people taking or planning to take testosterone can use most any method.

They referred to a PDF from the Reproductive Health Access Project, which states:

CAN YOU GET PREGNANT? 

If you have a uterus and ovaries, you can get pregnant. This is true even if you take testosterone. Although it may stop your monthly bleeding, testosterone does not keep you from getting pregnant. 

CAN YOU GET SOMEONE PREGNANT? 

If you have a penis and testes, you can get someone pregnant. This is true even if you take estrogen. Estrogen may lower your sperm count, but it does not keep you from getting someone pregnant. 

BIRTH CONTROL FOR PEOPLE TAKING TESTOSTERONE 

People who have a uterus and ovaries and who take testosterone can use any birth control method. The progestin pill, implant, IUD, and shot may help decrease monthly bleeding. Some people use one of these methods just to control bleeding, even if they don’t need birth control. Progestin does not interact with testosterone. Many people want to avoid methods with estrogen (pill/patch/ring). It is unclear if estrogen interacts with testosterone. The copper IUD prevents pregnancy and contains no hormones. Condoms prevent pregnancy and sexually transmitted infections (STIs). 

BIRTH CONTROL FOR PEOPLE TAKING ESTROGEN 

People who have a penis and testes and who take estrogen can use condoms. Their partners can choose any birth control method. 

PERMANENT OPTIONS 

Permanent methods are great for people who don’t ever want to get pregnant. These include tubal ligation, hysterectomy, orchiectomy, and vasectomy. 

Read the whole PDF here.

Read Helen’s blogpost here.

Illustration:  Anna Ivonina

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